If there is free flow, there is no pain; if there is pain, there is no free flow.
“It’s a classic medical maxim that is often used in Traditional Chinese Medicine (TCM),” Chelsea Tan, senior physician at Oriental Remedies tells me. It is a fundamental concept that provides a relatively straightforward answer to the question I’ve been brewing at the back of my mind for a while now. How do stress and upper physical tension such as headaches and migraines manifest outwardly? More specifically, does frowning—due to emotional stressors and such—cause our frown lines to set and deepen further as we age?
The short answer is yes. After all, repetition breeds habit, and habits are hard to break—the same can be said for our muscles. “Frown lines deepen through a combination of repeated muscle action and structural changes in the skin. Every time we frown, frown muscles contract and crease the skin above them—over years, this repetitive folding trains the skin to hold that shape even at rest,” explains Dr Harvey Ho, founder and medical director of Skinscape Clinic.
But there’s a root problem. Whilst a more relaxed lifestyle would be the easiest fix, most of us don’t have that privilege. Day in, day out, we are constantly subjected to the endless stressors of work, be it an impossible deadline or a colleague you can’t get along with. There’s a natural cause and effect, but if the cause isn’t something that can be removed at the snap of a finger, then how do we mitigate its effects? After all, we doubt anyone would like to be told that their frown lines will become more prominent even at rest, simply because of the daily stress we go through—and quite simply, can’t control.
Naturally, the beauty team at Vogue Singapore decided to investigate this for ourselves. Speaking to a TCM expert as well as a professional aesthetic doctor, we find out exactly how stress physically manifests on our face, how to release facial tension on a daily basis and what more can be done to alleviate the natural formation of frown lines.
How does stress directly manifest in our face and why does it cause frown lines?
“It is not stress itself that etches the lines, but the frowning and facial tension that often accompanies it. Many people unconsciously furrow their brow when they are stressed, concentrating, or squinting at screens, and it is the repeated muscle contraction that can gradually reinforce the crease over time,” explains Dr Ho.
However, according to Dr Ho, if stress does not translate into facial tension for you, it might not be a major driver of frown lines. Ultimately, frown lines are the manifestation of other external factors, so when a patient is concerned about frown lines in particular, Dr Ho’s advice would generally be to explore the other lifestyle factors that may be contributing to it, such as sleep, screen habits and workload.
Meanwhile in TCM, stress affects the whole body, and directly affects your qi (energy). “It causes the liver qi, the flow of energy and emotions in the body, and your blood to stagnate. This emotional stagnation physically manifests as a tightly furrowed brow. The chronically clenched muscles compress the local meridians (energy pathways) and blood vessels, completely blocking the free flow of qi and blood around your forehead and temples,” Dr Tan explains.
“The blocked energy and blood flow also tends to result in the throbbing sensation in the head, like your headaches and tension migraines.” To add, she explains that without the healthy flow of qi and blood, your skin is also not getting nourished. With everything stagnating up top, the skin between your brows is also starved of essential nourishment, losing its vitality and allowing frown lines to set in more easily and deeply.
What causes frown lines to be more pronounced?
“In Traditional Chinese Medicine, we embrace the philosophy of feel good, look good: your outer appearance is a direct reflection of your internal harmony. Wrinkles are far more than just surface-level signs of aging; they act as an external map of the body, mirroring deeper imbalances in your organs, qi, and blood. When our core vitality—our “essence and qi (精气亏虚)” runs low, or when poor circulation leaves the skin malnourished from within, the face loses its structural life force, giving way to creases and fine lines,” sums Dr Tan.
Whilst it is also the natural result of aging, Dr Ho also explains it as a result of repeated muscle action and repetitive folding of the skin, as mentioned previously. In addition to the frequency of frowning, there is also a “natural decline in collagen and elastin that comes with age, along with cumulative sun exposure, which thins the skin and reduces its ability to spring back. The result is a line that starts as a temporary crease during expression and gradually becomes etched into the skin even when the face is still”.
“Genetics and facial anatomy also play a role in how prominent these lines become, as does frequent squinting due to sunlight or uncorrected vision, which encourages the same repetitive frowning action,” Dr Ho further explains. Meanwhile, other lifestyle factors such as smoking can accelerate skin aging and speed up the process further. Whilst dehydrated or dry skin are not actual causes, he confirms that they can temporarily make existing lines look more noticeable.
At what point do frown lines start appearing more frequently?
“There’s no real fixed age—it depends heavily on genetics, skin type, sun exposure, and how expressive a person naturally is. That said, most patients start noticing the first signs in their late twenties to early thirties.
The progression is, however, generally predictable. Lines first appear only during movement (dynamic lines), then gradually become visible at rest as well (static lines), deepening in severity the longer the underlying muscle activity and collagen loss go unaddressed,” offers Dr Ho.
Is there a way to release tension in our face lines on a daily basis?
Dr Ho suggests trying to break the habit, with periodic self-monitoring and pausing at intervals throughout the day to notice whether the eyebrows are being unconsciously drawn together.
“Gentle massage of the temples, forehead, and the area above the eyebrows may also help release built-up tension, although it is important to avoid aggressive pulling or stretching of the skin. As facial tension is often an extension of general physical or emotional tension, adequate sleep, breathing exercises, stretching, and broader stress management may also help reduce unconscious muscle contraction in the face,” he offers.
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For some however, certain bells are already ringing. After all, what daily ritual can be better than facial gua sha? As Dr Tan posits, facial gua sha is a mindful form of meditation for your skin, dedicated to releasing muscle tension and boosting circulation. Implementing it can certainly break up any stress or tension that accumulates in your jaw, brow, and forehead—the prime spots where wrinkles love to form.
“From a TCM perspective, gua sha actively clears stagnant qi and blood, the two main culprits behind dull complexion and deep lines. By releasing muscle tension and boosting circulation every day, you don’t just smooth surface creases; you actively nourish your skin from the inside out, making it the perfect ritual to feel good and look good,” she adds.
Are there specific aesthetic treatments one can adopt in order to reduce frown lines?
“Of course, the most direct treatment would be botulinum toxin, commonly referred to as botox. It temporarily reduces excessive muscle contraction, allowing the overlying skin to smooth out, and is specifically approved for the temporary improvement of moderate-to-severe frown lines between the brows,” starts Dr Ho.
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But the aim is not to ‘freeze’ the forehead. “With appropriate dosing and placement, the muscles can be relaxed while natural facial expression is preserved. For deeper lines that remain visible at rest, there should be a combined approach consisting of not just botox to reduce the repeated muscle movement; but also topical retinoids and daily sunscreen for preserving skin quality; laser resurfacing or microneedling treatments that can stimulate collagen; or skinboosters and collagen stimulators that can improve hydrating or dermal quality,” suggests Dr Ho.
What sort of TCM treatments can be done to alleviate stress and frown lines?
For a more natural approach, one can consider facial acupuncture, which is a deeper, more targetted treatment in TCM. “While gua sha lovingly nurtures the skin and fascia on the surface, ultra-thin needles go a step further—physically reaching the underlying muscle tissue to stimulate precise meridian points and heal from within. To reduce stubborn frown lines, the needles work by physically “un-knoting” the hyperactive muscles between your eyebrows that lock up from stress or squinting. The insertion triggers a micro-relaxation response in the tightly contracted muscle fibers while creating a “positive micro-trauma.” This alerts your body to kick into repair mode, sending a surge of fresh qi, blood, and nutrients to the area to naturally stimulate new collagen and plump up the crease from within.” deep dives Dr Tan.
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In this case, think of your TCM practitioner as a traffic controller. “By needling those specific stagnation points, they break up the traffic jam, restoring the “free flow of energy” to simultaneously reduce the headache and smooth out the frown lines,” she further explains.
My own personal experience of facial acupuncture—combined with a short facial gua sha session afterwards—was rewarding, and telling too. As someone who is consistently on the go and waterboarded with daily work stressors, my half hour session of facial acupuncture was much-needed, putting me into a more relaxed state. After removing the needles and doing gua sha, there was visible redness in my face—a tell that blood was circulating and being propelled to my face. My usually furrowed brow lines felt less tense, as if the tension had melted away, even if momentarily. My sleep that evening was arguably better too.
“From a TCM perspective, the space between the brows is heavily tied to the liver meridian, where chronic stress and frustration manifest as stagnant energy and a furrowed brow. Acupoints like EX-HN3 Yintang (between the eyebrows) unblock this liver qi stagnation, which calms the nervous system and melts away anxiety. By relieving both the emotional stress and physical tension at the root, it stops you from unconsciously frowning, honouring the philosophy of feeling good to look good,” Dr Tan adds.
